Context: Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity.
Methods: We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January-July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records.
Results: 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50-7600pg/ml), followed by 5F PB-22 (7, 30-400pg/mL), MDMB-CHMICA (7, 80-8000pg/mL), AB-CHMINACA (3, 50-1800pg/mL), Cumyl 5F-PINACA (1, 800pg/mL) and BB-22 (1, 60pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care.
Conclusions: Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.

@article{8563688,
abstract = {Context: Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity.
Methods: We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January-July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records.
Results: 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50-7600pg/ml), followed by 5F PB-22 (7, 30-400pg/mL), MDMB-CHMICA (7, 80-8000pg/mL), AB-CHMINACA (3, 50-1800pg/mL), Cumyl 5F-PINACA (1, 800pg/mL) and BB-22 (1, 60pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care.
Conclusions: Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.},
author = {Abouchedid, Rachelle and Hudson, Simon and Thurtle, Natalie and Yamamoto, Takahiro and Ho, James H and Bailey, George and Wood, Michelle and Sadones, Nele and Stove, Christophe and Dines, Alison and Archer, John RH and Wood, David M and Dargan, Paul I},
issn = {1556-3650},
journal = {CLINICAL TOXICOLOGY},
keywords = {DEATH FOLLOWING USE,MDMB-CHMICA,INTOXICATION,CONSUMPTION,Drugs of abuse,Emergency Department,new psychoactive substances,synthetic cannabinoid receptor agonists,acute toxicity},
language = {eng},
number = {5},
pages = {338--345},
title = {Analytical confirmation of synthetic cannabinoids in a cohort of 179 presentations with acute recreational drug toxicity to an Emergency Department in London, UK in the first half of 2015},
url = {http://dx.doi.org/10.1080/15563650.2017.1287373},
volume = {55},
year = {2017},
}